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300 Longwood Avenue
Boston, MA 02115
(617) 355-6000
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Research:
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Footage from Children's Archives:
Caring for Polio Patients
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The following video, which is comprised of excerpts from a training film shot ca.1955 by William T. Green, MD, gives a brief glimpse into the care of patients during early convalescent phases of polio. It shows the application of full body hot packs, pool therapy, care for a patient within an iron lung and therapy in Children's Hospital Boston "functional room."
The film is narrated by by physical therapist Claire McCarthy, who appears briefly in the film. Claire has been a member of Children's physical therapy staff since 1953.
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Remember, this video is 50 years back in time: high-tech innovations and materials such as plastic were not available. Patients were very sensitive to touch and simple movements [were] very painful.
This is the sheeted bed with the hospital tight corners -- no fitted sheets. The footboard to support feet at a 90 degree angle. The log roll was used, as lifting would be painful, as would unexpected bending.
These are full body hot packs -- heated , hot, wrung out in the machine, as you see to your right. The hot packs were readied, temperature tested on the patient to be sure they were comfortable, laid on and quickly covered with a plastic-topped blanket to maintain the heat. Legs were individually wrapped, and the hot packs generally lasted 20 to 30 minutes.
Hot packs were always followed by flexibility exercises -- sometimes done by nurses or even family members, who were carefully taught. This is a physical therapist who would be including muscle re-education exercises. Note the patient is responding, "OK, that's enough."
This was not the newest version of the Hubbard Tub used at the time, but the principle is the same. Shaped so therapists were closer to the patient to preserve the backs of the physical therapists. The temperature was at 101 degrees for warmth and comfort like a bath and the buoyancy of the water helped weakened muscles move more easily.
Progression to the pool: You see John Brown, our wonderful Scotsman, lower a patient into the pool. The temperature of the pool was 95 to 96 degrees -- still warm. Treatments were obviously easier for the therapists, but patients could also do a number of activities that were difficult to do on dry land -- and this included beginning to walk. As you can see we have parallel bars inside the pool as well.
Patients with difficulty breathing were placed in the respirator to minimize stress and fatigue on breathing muscles. Treatment and care continued within the respirator with little interruption.
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The mirror allowed patients to see their environment. It also allowed caregivers to watch the patient's face for responses, especially pain.
Entering and exiting the tank by caregivers was done very carefully. You see the therapist watching the gauge so that entrance is between inhalation and exhalation. Otherwise you would knock the wind out of the person -- not a pleasant experience!
The head bubble, or positive pressure dome, allowed exercises and care that required more space. As you can see, the therapist started to talk to the person and had to lean down to the neck opening to be heard.
Progression was to the rocking bed, which helped the patient's diaphragm ascend and descend for breathing. Exercises were at times easier for the therapist and at time pulleys could help. I think this was the predecessor to the current CPM machines. [A CPM machine is used to help rehabilitate a limb.]
Bivalved casts were either short or long. They were a staple for preventing deformities and providing support. Remember, plastics did not exist. They had to be applied very carefully to prevent pressure sores in the heel.
The triple Gatch bed [was] truly an asset in allowing patients to sit and eat in relative comfort. This was a milestone for patients to be able to sit and eat on their own and being independent. The only hazard to the triple Gatch bed was to caregivers when handles were not tucked back under the bed.
The impact of residual muscle weakness in the hand; the intrinsic muscles are being examined. These muscles allow us the dexterity and multiple uses of our hands. Splints for long term use were custom made -- remember, no plastics were available. Temporary supports were also custom made, but of plaster.
The impact on lower extremities is similar. Joint alignment and support by bracing and use of crutches is obvious.
Further glimpses into additional, but necessary, training: Our high-tech hydraulic parallel bars to help with teaching techniques to manage the inclines and declines -- of going up and down ramps.
Stairs were made to Boston specifications -- five- to six-inch risers with lips for added difficulty and, of course, the curved stair case. If you could manage these stairs, you could manage any building in Boston. A sample of the technique of climbing stairs with bilateral long leg braces being done very well. And the curbs -- there were no curb cuts in Boston streets. So in order to get up and down -- to cross the street -- you had to manage a curb.
Our homemade adjustable chair -- made in-house -- was made so we could adjust the seat height and independent arm height, for training individuals of various heights, sizes, and degrees of weakness.
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